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3a - GP > Men's health > Flashcards

Men's health Flashcards

1
Q

What is erectile dysfunction (impotence)

A

the persistent inability to achieve or maintain an erection sufficient for sexual performance

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2
Q

Give 5 RFs for erectile dysfunction

A
  • increasing age
  • coronary and peripheral arterial disease
  • excess alcohol and smoking
  • metabolic syndrome: HTN, hyperlipidaemia, diabetes, obesity
  • drugs: SSRIs and beta blockers
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3
Q

Give 3 factors favouring an organic cause of impotence

A
  • Gradual onset of symptoms
  • Lack of tumescence
  • Normal libido
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4
Q

Give 4 factors favouring a psychogenic cause of impotence

A
  • Sudden onset of symptoms
  • Decreased libido
  • Major life events
  • History of premature ejaculation
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5
Q

How is impotence investigated

A
  • fasting glucose and lipid profile to calculate Qrisk
  • all men with ED should have their testosterone levels checked
  • Free testosterone should be a morning sample (9-11am)
  • If free testosterone is low or borderline, it should be repeated along with FSH, LH and prolactin levels
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6
Q

Name two questionnaires are used in the assessment of impotence

A
  • international index of erectile dysfunction (15 Qs)
  • sexual health inventory for men (5 Qs)
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7
Q

Non-pharmacological management of impotence

A
  • treat underlying condition
  • reduce weight, improve diet, increase exercise
  • psychosexual therapy
  • referral to urology if the patient is young
  • Stopping cycling for a trial period, if a man regularly cycles for more than 3 hours a week
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8
Q

Pharmacological management of impotence

A
  • phoshodiesterase-5 (PDE5) inhibitors - e.g sildenafil, ‘Viagra’, tadalafil or vardenafil
  • vacuum erection device if PDE5 CI
  • alprostadil penile intracavernous injections
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9
Q

Give 3 contraindications to PDE5 inhibitors

A
  • Hypotension
  • Unstable angina or angina occurring during sexual intercourse
  • MI in the last 90 days
  • stroke in last 6 months
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10
Q

Give 4 side effects of sildenafil

A
  • visual - blue discolouration
  • headache
  • nasal congestion
  • flushing
  • priapism
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11
Q

When is the peak incidence of testicular cancer

A

age 20-34

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12
Q

What is the most common type of testicular cancer

A

Germ cell tumours

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13
Q

What are the two main types of germ-cell tumours in testicular cancer?

A
  • seminomas
  • non-seminomas
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14
Q

Name some types of non-seminoma germ-cell tumours.

A

Embryonal, yolk sac, teratoma, and choriocarcinoma.

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15
Q

Name 2 non-germ cell tumours associated with testicular cancer?

A

Leydig cell tumours and sarcomas.

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16
Q

What is the peak incidence age for teratomas in testicular cancer?

A

25 years.

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17
Q

What is the peak incidence age for seminomas in testicular cancer?

A

35

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18
Q

Name some risk factors for testicular cancer.

A
  • Infertility
  • cryptorchidism
  • family history
  • Klinefelter’s syndrome
  • mumps orchitis.
19
Q

symptoms of testicular cancer

A
  • a painless testicular lump - mc
  • occasionally presents with pain
  • hydrocele
  • gynaecomastia
20
Q

Why does gynaecomastia occur in testicular cancer?

A

Due to an increased oestrogen:androgen ratio.

21
Q

What are the tumour markers associated with testicular cancer

A
  • seminomas: hCG may be elevated
  • non-seminomas: raised AFP and/or beta-hCG
  • LDH is elevated in around 40% of germ cell tumours
22
Q

What is the first-line diagnostic test for testicular cancer?

A

Ultrasound

23
Q

How is testicular cancer managed?

A
  • Orchidectomy
  • chemotherapy or radiotherapy depending on staging and tumour type.
24
Q

What is the most common cause of scrotal swellings seen in primary care

A

Epididymal cysts

25
Features of epididymal cysts
* separate from the body of the testicle * found posterior to the testicle
26
What is a hydrocele
accumulation of fluid within the tunica vaginalis
27
Features of a hydrocele
* soft, non-tender swelling on one side of the scrotum that transilluminates * the swelling is confined to the scrotum, you can get 'above' the mass on examination
28
How are hydroceles managed
* infants: repaired if they do not resolve spontaneously by the age of 1-2 years * adults: USS to exclude tumour, conservative
29
What is the typical cause of acute bacterial prostatitis?
Gram-negative bacteria (Escherichia coli) entering the prostate gland via the urethra
30
What are some risk factors for acute bacterial prostatitis?
* Recent UTI * urogenital instrumentation * intermittent bladder catheterisation * prostate biopsy
31
Features of acute bacterial prostatitis?
* pain of prostatitis may be referred to a variety of areas including the perineum, penis, rectum or back * obstructive voiding symptoms * fever and rigors
32
What would a digital rectal examination reveal in a patient with acute bacterial prostatitis?
A tender, boggy prostate gland
33
Management of acute bacterial prostatitis
* 1st line: ciprofloxacin BD 14-day * above CI: trimethoprim * screening for STIs in a young male
34
Most common form of prostate cancer
adenocarcinoma
35
RFs of prostate cancer
* increasing age * obesity * Afro-Caribbean * FHx
36
Features of prostate cancer
* bladder outlet obstruction: hesitancy, urinary retention * haematuria * pain: back, perineal or testicular
37
What would a digital rectal examination reveal in a patient with prostate cancer?
asymmetrical, hard, nodular enlargement with loss of median sulcus
38
Investigations of prostate cancer
* first line: multiparametric MRI - results reported using a 5-point Likert scale * If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
39
management of Localised prostate cancer (T1/T2)
* conservative: active monitoring & watchful waiting * radical prostatectomy * radiotherapy: external beam and brachytherapy
40
management of Localised advanced prostate cancer (T3/T4)
* hormonal therapy * radical prostatectomy * radiotherapy: external beam and brachytherapy
41
common complication of radical prostatectomy
erectile dysfunction
42
Complications of radiotherapy for prostate cancer
* proctitis * increased risk of bladder, colon, and rectal cancer
43
What are the common approaches to hormonal therapy for metastatic prostate cancer?
Anti-androgen therapy: * synthetic GnRH agonists (goserelin) or antagonists (degarelix) * bilateral orchidectomy

3a - GP (13 decks)

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